Erbay M., Yilmaz O., Korun O., Sahin I., Dikkas U., Turhan M., ...Daha Fazla
JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY, cilt.17, sa.4 Supplement, ss.22-23, 2023 (SCI-Expanded, Scopus)
Özet
Introduction: Vascular rings are rare congenital anomalies of the aortic arch and/or its derivatives that cause compression of the tracheobronchial tree leading to respiratory and esophageal symptoms. Diagnosis can be easily made by using reconstructed three-dimensional (3D) computed tomography (CT) imaging and the pre-planning of the surgical procedure can be improved by 3D printing of the heart anatomy. Our abstract describes a vascular ring patient presented with dyspnea and misdiagnosed as having asthma.
Methods: Echocardiography revealed no significant abnormalities. Bronchoscopy showed 20% narrowing in the trachea and 80% narrowing in the proximal left main bronchus. Reconstructed 3D CT imaging showed a vascular ring structure of right aortic arch and aberrant left subclavian artery (LSCA). The raw cross-sectional imaging data was converted into a 3D digital model, processed in the MIMICS program, and printed as a 3D model (Image 1). On the heart team meeting, division of the aberrant LSCA from the descending aorta with reanastomosis to the left common carotid artery (LCCA) and division of the probable ligamentum arteriosum was planned. Using the reconstructed-3D CT image we measured the distance to LCCA from 4th intercostal space, which was 6.61mm (Image 2). Patient underwent surgery through left lateral thoracotomy and the procedure was performed as planned.
Results: The patient stayed in the intensive care unit for 3 days postoperatively. She had chylothorax which was resolved with medical management. She was discharged on the 25th postoperative day.
Conclusions: In cases of right aortic arch with aberrant LSCA, where reanastomosis of the LSCA is contemplated, the critical decision is whether to approach through the sternotomy or left thoracotomy. Left thoracotomy is the preferred approach because of the proximity of the aberrant artery and descending aorta to the surgeon. However, if the LCCA is out of reach through thoracotomy, the operation should be performed through sternotomy under cardiopulmonary bypass. The use of 3D CT imaging and 3D printing can greatly aid in pre-operative planning, leading to improved outcomes as in our case.